Hospital at home for psychiatric patients is a new emerging resource of delivering acute mental health care in the community. The main objective of this program is to provide intense care to patients with severe mental disorders at home as an alternative to acute admission.

Although home hospitalisation has begun to develop widely in recent years there is a notable lack of studies

The CAEM Psychiatric Home Hospitalization Unit (HAD-CAEM) has been operating since 2018 and takes place in Santa Coloma de Gramenet; and from March 2022 also in a part of Badalona. Both are sociodemographically depressed areas near Barcelona.

The aim of this study is to describe the characteristics of patients attended at the Psychiatric Home Hospitalization Unit of our hospital and to study differences according to area and place of referral.

Socio-demographic and clinical data were collected retrospectively at admission and discharge of all patients treated at HAD-CAEM between March 2022 to february 2023.

Statistical analysis was performed by using SPSS program.

85 patients were included in the study. 45.9% were women. The mean age was 45.5 years (SD 15.58 years). The main diagnoses of the sample were psychosis and schizophrenia (38.8%), Bipolar disorder (23.53%), Depressive disorder (21.18%), schizoaffective disorder (8.24%) and others (8,24%).

54 (63.53%) patients were from Santa Coloma area and 35 (41.18%) from Badalona area.

The total mean duration of admission was 40.22 days (SD 26.18 days), with a mean follow-up of 10.09 visits (SD 5.39 visits) and 2.41 teleassistence (SD 2.62).

The mean duration of admission for Santa Coloma patients was 43.98 days (SD 28.59), and for Badalona patients 33.68 days (SD 20.13). Trend without significance is observed (t= 1.77, p=0.08)

We found differences in the mean duration of admission according to referral location. Acute psychiatric unit 33.25 days (SD 18.06), Mental health Center 51.93 days (SD 33.45), Emergencies 34.28 days (SD 19.69) (F=5.1, p=0.008).

Sociodemografic and clinical característics obtained in our study are consistent with those reported in previous studies. The duration of admission of patients referred from the mental health center is longer than those referred from the acute psychiatric or emergency unit. Home hospitalization teams have been increasing in recent years, being an alternative to traditional hospitalization.

None Declared

There is an urgent need to address pervasive inequities in health and healthcare in the USA. Many areas of health inequity are well known, but there remain important unexplored areas, and for many populations in the USA, accessing data to visualize and monitor health equity is difficult.

We describe the development and evaluation of an open-source, R-Shiny application, the “Health Equity Explorer (H2E),” designed to enable users to explore health equity data in a way that can be easily shared within and across common data models (CDMs).

We have developed a novel, scalable informatics tool to explore a wide variety of drivers of health, including patient-reported Social Determinants of Health (SDoH), using data in an OMOP CDM research data repository in a way that can be easily shared. We describe our development process, data schema, potential use cases, and pilot data for 705,686 people who attended our health system at least once since 2016. For this group, 996,382 unique observations for questions related to food and housing security were available for 324,630 patients (at least one answer for all 46% of patients) with 65,152 (20.1% of patients with at least one visit and answer) reporting food or housing insecurity at least once.

H2E can be used to support dynamic and interactive explorations that include rich social and environmental data. The tool can support multiple CDMs and has the potential to support distributed health equity research and intervention on a national scale.

To analyze the different combination of personality pathology associated to variables of psychiatric hospital admissions (number of admissions, total of days spent as psychiatric inpatient, average of days for admission, and number of admissions in a day care hospital).

The ICD-10 and DSM-IV modules of the semi-structured interview IPDE (International Personality Disorders Examination) were administered, in a sample of 107 adolescent psychiatric patients (M=15.8, SD=0.8 years old; age rank 15-17; 79% female).

Personality pathology group identified by the IPDE showed significantly higher number (p< .001) of psychiatric admissions (M=1.48) than no personality pathology group (M=0.57), but not significant higher number of admissions in a day care hospital. Psychotic patients showed the highest rate of admissions (M=2.88). In present sample, between 30% and 38% of all hospital admitted patients showed a Cluster B personality disorder (PD).The users of psychiatric inpatient services with a complex PD (two o more PD from different clusters) presents in average: 2-2.5 admissions, 34-53 total days spent as psychiatric inpatient, and 11-16 days on each admission.

Patients with psychotic disorders or complex PD were the highest users of inpatients services, but not of day care hospital admissions.

The aim of this study was to asses the impact of different psychological and/or biological effects in the recovery from surgery.

The sample was composed of 42 patients waiting for a surgical intervention. Patients with cognitive impairment were removed from the sample. Prior to surgical intervention (48 to 72 hours), patients were administered the Millon Clinical Multiaxial Inventory-II (Millon, 1986) and salivary cortisol were measured 24 hours before surgery. Following surgical intervention, recovery was coded as good or poor accordingly to Moix et als criteria (1995). Dietary intake, resting and sleeping hours, as well as the existence of fever, perceived pain and related surgery complications were daily registered and controlled for.

The cortisol values were increased in patients with high score in Histrionic Scale (t = 2.10, p = 0.043). There was a significant relation between personality, cortisol and recovery. the patients with low score in Dependent Scale (t = 2.33, p = 0.029), Histrionic Scale ( t = 2.51, p = 0.020), Alcohol Dependence Scale (t = 2.01, p = 0.049), Drug Dependence Scale (t = 2.08, p = 0.050) and cortisol show better recovery from surgery.

The results of this study indicate that psychological factors and levels of cortisol may have a critical rol in post-operatory recovery. Taking these data into account, it seems necessary to assess psychopathology on a regular basis in all the patients waiting for surgically interventions.

Several studies have suggested that nicotine could have beneficial effects on cognitive functioning.

To explore the association between smoking and cognitive functioning in bipolar disorder and schizophrenia.

Observational study. We analyzed data from 184 participants in 3 groups (61 healthy controls, 47 euthymic patients with bipolar-I disorder, 76 patients with clinically stable schizophrenia) assessed by a neuropsychological battery. Statistical analysis was performed comparing subgroups of smokers and non-smokers data. Both groups were demographic and clinically comparable.

Smoking rate was higher in participants with bipolar disorder and schizophrenia (X 2 = 26.8, p = 0.001). Bipolar Group: neuropsychological performance was similar in smokers (n = 28) and non-smokers (n = 19) except perseverative errors of the Wisconsin test, in which smokers performed significantly worse (t = −2.1, p = 0,03). Schizophrenia group: smokers (n = 46) performed significantly better than non-smokers (n = 30) in the verbal fluency test (t = −2.46, p = 0.046), finger tapping right (t = −2.19; p = 0.03) and immediate (t = −2.84, p = 0.006) and delayed recall (t = −2.59, p = 0.01) of Rey figure test.

This is the first study comparing these clinical groups. The global cognitive function in euthymic state was similar in both groups despite of smoking status. However, smoking could be associated with a worse executive function in bipolar disorder. In patients with schizophrenia smoking was associated with better performance in visual memory, verbal fluency and motor speed, but not attention.

The clinical diagnosis of personality disorder in adolescence tends to be conservative and unspecific.

To examine the prevalence of personality disorder, and the involvement of stigma effect in adolescents with Axis I psychiatric disorders.

A sample of 100 patients with psychiatric disorders (M = 15.8, SD = 0.9 years, range 15-17, 70% women), were assessed and diagnosed for personality disorders in a mental health public centre.

The prevalence of PD identified by clinicians (12%), differs from the prevalence identified by the semi-structured interview (34–37%) showing a greater number (p < .001) of people affected. In the present sample most of the cases identified by clinicians are related to personality disorders (PD) not otherwise specified, while with the implementation of semi-structured interviews, most of the sample met criteria for Cluster B PDs. Additionally, 11% of the sample has dimensional pathological features (probable PD) without complying categorically the criteria for a full PD.

In clinical settings, a considerable proportion of adolescents with psychopathology meet features for PD, although few of them have a confirmed clinical diagnosis. Considerations about impact of the stigma are discussed.

Sleep disturbances have been described in drugdependent patients and mainly, in alcoholics. Few studies describe the hypnotic treatment used in this setting.

Describe the prevalence of insomnia in drugdependent inpatients. Describe the hypnotic treatment, according to the substance abuse and the psychiatric comorbidity.

Descriptive study performed in drugdependent inpatients between June, 2008 and August, 2011. The Structured Clinical Interview for DSM Disorders was obtained in order to ensure the clinical diagnosis. Hypnotic treatment was dispensed to those patients who complain of insomnia according to the Psychiatric prescription. Demographic data, type of abuse drug and the hypnotic dispensed was obtained.

298 patients fulfilled inclusion criteria (71.8% men, 39.22 ± 10.13 years). The principal substances of consumption were stimulants(36.2%), followed by alcohol(34.9%), heroine(14.4%), cannabis(9.4%) and benzodiazepines(5%). 60.4% of the patients complained of insomnia during the hospital admission. The most used drugs for insomnia were mirtazapine(19.8%), trazodone(14.8%), quetiapine(14.1%), clotiapine(7.4%) and olanzapine(4.4%). Alcohol, cocaine and benzodiazepines addicted patients were treated with antidepressants as mirtazapine(17.3%, 18.5% and 40% respectively); heroin addicts were treated with antipsychotic drugs as quetiapine(27.9%). Cannabis addicts took antidepressant and antipsychotic (mirtazapine (21.4%) and olanzapine(21.4%))

61.7% of the patients fulfilled diagnostic criteria of dual diagnosis. Patients with psychotic disorder used quetiapine(17.4%); those with depressive and bipolar disorder were treated with trazodone(30.2% and 33.3% respectively), those who complain of anxious disorder and personality disorder took mirtazapine(50% and 17.4% respectively).

Sleep disturbances are frequent in drugdependent inpatients. Mirtazapine was the most frequently used drug to treat insomnia.

Depression is a disease with high prevalence all over the world. Selective serotonine reuptake inhibitors (SSRIs) and dual antidepressants (DA) are worldwide used to treat the different types of depressive episodes. Between the adverse events of these compounds, an unusual but potentially severe side effect is the syndrome of inapropriate antidiuretic hormone secretion (SIADH).

Several cases published, and an amount of cases series have documented the association of SIADH to the use of SSRIs and DA. All SSRIs and DA are at risk of producing SIADH (fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram, escitalopram, venlafaxine and duloxetine). Old age has been found as a risk factor for developing SIADH. There are not enough data to conclude that other risk factors can play a role in the development of this adverse event. Treatment should include the immediate withdrawal of the antidepressant. The introduction of other antidepressants is controversial, as SIADH has been related with all antidepressive treatments; but the risk of relapse into a depressive episode must be considered also. Between symptomatic treatments, the control of water intake and the use of low doses of loop diuretics can be recommended. Severe cases can be treated with higher doses of loop diuretics and saline hypertonic solution.

SIADH has been related with SSRIs and DA antidepressants and it is an infrequent but severe adverse event. Its risk must be considered when prescribing treatment with them. If this adverse event is produced, the substitution of the antidepressant should be done.

The authors have not supplied their declaration of competing interest.

Bipolar disorder (BD) is related to high prevalence of somatic comorbidities, health care costs, and premature mortality [1]. Some evidence supports the view of BD as chronic, progressive and multisystem disorder in which not only mental system, but also somatic systems are involved [2].

To investigate differences in physical health in patients with bipolar disorder at different stages (early vs. late) of the disease.

Cross-sectional, naturalistic, multicenter study. Sample: 110 outpatients with BD [68 early stage (diagnosed at least 5 years earlier) and 42 late stage (at least 20 years earlier)]. Assessment: demographic and clinical variables; psychopathology: HDRS, YMRS and CGI; biological information: anthropometric, vital signs and lab results.

Early stage group: mean age 40.1 (11.9), 66.2% females and CGI = 3.6 (1.4). Late stage group: mean age 55.8 (8.2), 69.0% females and CGI = 4.0 (1.4). Patients in early stage have significantly higher levels of glucose (t = −4.007, P < 0.001), urea (t = −2.724, P = 0.008), creatinine (F = 0.560, P = 0.022), triglycerides (t = −3.501, P = 0.001), Fe (t = 2.871, P = 0.005) and insulin (t = −3.223, P = 0.002). Moreover, they have higher Body Max Index (BMI) (t = −3.728, P < 0.000), abdominal circumference (t = −4.040, P < 0.000) and greater number of somatic comorbidities (t = −2.101, P = 0.041).

– patients with bipolar disorders in late stages have worse physical health than those in early stage.

– these results could be an indication that bipolar disorder might better viewed as a multisystem disorder.

The authors have not supplied their declaration of competing interest.